“George” is pleased that his blood pressure is reasonably well controlled but frustrated that he struggles with a mild cough that makes his job more difficulty. He has mentioned this before to his former doc but was told to stay on the same meds. He is also worried about his family history of heart disease. He does not feel that he has been able to address these questions adequately. He feels that he never has enough time with his doctor and is frustrated that he has to wait 6 months between visits.

“George” comes to his initial visit. There, he spends an hour reviewing his past medical history and family history with his physician. He reviews his medications and his social history. He shares his frustrations at his cough. He reveals that his father had his first heart attack at 55 and he worries that he is headed down the same path. George feels tired and wishes he could have more energy to play with his young children. He just doesn’t sleep well and his wife tells him he snores.

After listening to George’s story and asking some follow up questions, Dr. Owen makes some initial recommendations.

• change blood pressure meds to get rid of the cough, a well known side effect

• discusses and orders a sleep study.

• orders a thorough set of labs, drawn through the office which generally cost much less than his insurance charges him.

• recommends a home blood pressure cuff to get a better understanding of his readings.

Before he leaves the office, a follow up is arranged in 4 weeks to discuss results. He is provided with information on blood pressure including when and how to contact the office. Because of his busy schedule, they agree to a telehealth appointment for the next visit, helping George save his precious time off for his family and other needs.

George routinely had been sending Dr. Owen his blood pressure readings and, with a quick phone call, he had increased his dose. Now, his readings show good control.

George had completed his sleep study and was found to have mild sleep apnea. He is waiting on a sleep medicine consult.

During the telehealth visit, Dr. Owen confirmed that his nagging cough had resolved. They discussed sleep apnea and the importance of treating it.

She reviewed his labs and discussed that although he was not diabetic, his blood sugars were a little higher than normal. Together, using the SMART goal tool, they created a plan to work on lifestyle measures that fit into George’s busy life.

George left feeling well prepared to manage his health. They arranged a 3 month follow up but Dr. Owen requested an update on his SMART goal in a month!

Betsy had called her primary care practice in Massachusetts and got an appointment a few weeks before her move. She had not met the provider before and it felt quite rushed. She tried to explain her elbow pain but the provider took a quick look and ordered an xray. It showed arthritis and she was told to see physical therapy. Unfortunately, physical therapy was booking out beyond her move date. She was told to take ibuprofen and use ice. She did not have time to ask about her diabetes and was told that this would need another visit. So, she was discharged with a physical therapy appointment she could not keep and an appointment after her move date.

Upon signing up with Dr Owen, Betsy was thrilled to be seen within a few weeks of her first call! She transferred her records promptly.

When she got to the office, she was greeted by Dr. Owen who took a thorough history, including learning she is an avid hiker and kayaker and is quite anxious about her elbow pain as it would make both of these activities more difficult. She did not take the ibuprofen because she heard that it was dangerous for her. She wonders if she needs another imaging test because it wasn’t better. .

Betsy expressed a desire to avoid medications whenever possible and prefers to also avoid surgical interventions. After a careful exam, Dr. Owen determined that she had “tennis elbow”, not unexpected after all the packing and moving. Dr. Owen recommended a two week trial of a forearm strap to offload the injury with instructions to call if not better. They both agreed that additional imaging would not change the course of action at this time so they decided to hold off.

Betsy was relieved to hear that nothing serious was found and was then happy to be able to discuss her diabetes. Dr. Owen ordered routine labs and they agreed that a follow up appointment in a few weeks, after the tests were back, would be appropriate. Dr. Owen had Betsy sign a release to get the most recent labs.

Betsy left the office with a follow up appointment already scheduled, instructions on what to do for her elbow, and a lab slip. She left with information on “tennis elbow” and felt confident that she would be able to reach Dr. Owen if things did not improve as expected. She began to look forward to her summer of kayaking again now that she was less concerned about her elbow.

On a Thursday afternoon, Betsy called Dr. Owen on the patient line. She got a call back 30 minutes later. Betsy was experiencing mild burning upon urination. She had a long history of urinary tract infections and was worried this was another one. She was worried because the weekend was coming. She didn’t want to end up in urgent care.

Dr. Owen carefully asked some screening questions, including any history of antibiotic resistance. Betsy mentioned 2 antibiotic intolerances and 1 allergy. After discussion, as there were no “red flags”, they agreed that Betsy would swing by the office to give a urine sample. Given her antibiotic sensitivities, Dr. Owen discussed waiting until the early culture results were in before treating, unless symptoms worsened, reassuring Betsy that she could call the office on Saturday morning if she had not heard or if anything changed.

They agreed to meet for their previously scheduled visit regardless to take time to review her diabetes care in detail.

Sarah had been with the same practice for the past 15 years. Unfortunately, about 3 years ago, her long time physician retired. Since then, she has seen 4 different providers in that office for her routine care. She rarely sees anyone twice in a row, now and misses the easy feeling of her appointments with her physician of 12+ years. She often has several appointments in a month and feels as if no one is communicating. She has had medications changed and fears that one will interact with another. She has been to the ER twice in the past year for uncontrolled blood pressure. She wishes she had someone to watch over her care and feels that there are too many pieces to her puzzle.

Sarah comes to Winding Brook feeling lost in a system she doesn’t understand. She knows that her medical conditions are complicated but doesn’t really understand why. She has been told various things by her specialists but they don’t always seem to “match up”. She doesn’t feel as if anyone really “knows” what is going on…

When she meets Dr. Owen, Sarah shares her frustrations. Dr. Owen thanks her for being so open with her concerns! She encourages questions and shares that she wants Sarah to walk out the door with a clear plan in place.

Dr. Owen and Sarah go over her medical conditions, review which specialists she is seeing, discuss her medications, and share the mutual excitement about being “lacrosse moms”. She reviews the records that have arrived and confirms that her labs are up to date.

Because Sarah’s records are scattered across 3 health care systems, Dr. Owen asks Sarah to sign releases to obtain her records. Fortunately, at the time of her visit, Sarah was doing okay. Dr. Owen acknowledged Sarah’s distress at her fragmented care and Sarah’s fear that “something will go wrong”. Dr. Owen discusses how to get the most out of her visits with her specialists and encourages her to share the practice’s direct line with them to make it easier to communicate. They discuss a way to keep track of her visits and, seeing as Sarah was feeling more confident in her care but a bit overwhelmed, the two agree to a follow up in a month to review her records and Dr. Owen assures Sarah that she will be active in coordinating her care.

When Sarah comes back a month later, she is pleased to see that not only has Dr. Owen received her records, she has reviewed them and has contacted her cardiologist to confirm her dosing on a medication. Since Sarah had to travel over an hour to see her cardiologist, a burden to this very busy woman, Dr. Owen had also discussed with him setting up a plan of care that Dr. Owen could help Sarah follow. They were able to reduce the number of trips out of town she made and also decrease the number of blood draws she needed by collaborating with her specialists.

At this visit, Dr. Owen focused on engaging and empowering Sarah to be an active participant in her own care. They talked about keeping an updated medication list on the patient portal. Dr. Owen also discovered that Sarah often forgot her mid afternoon medications. Looking them over, a simple change in timing reduced the number of dosing times from 3 down to 2.

At the end of the visit, the two decided on another appointment date and Sarah asked for additional information regarding one of her medications. Dr. Owen recommended a few more short interval appointments to help Sarah get a handle on her medical care.